3/8 Jack amps 42 +1 66 +3 73 +4 80 +5 110 +6 153 +7 193 +9 283 pmps 352

[saltycat]

yesterdays condo

I'm so confused with my boy right now, it seems he is back to being completely unpredictable. I thought he would have stayed higher last night. I briefly remember my alarm going off this am, I must have turned it off and fallen back asleep which is usually pretty hard for me to do.

Even with a small reduction back to 30u, he went from 311 at pmps to a 42 at amps without much warning. This am, I reduced it back to 24 after yesterdays 20u pushed him back into the 300's. His numbers just aren't climbing like they should telling me to be on my toes today. Already gave some mc at breakfast and a little HC at +3 to build up a little buffer.

Is it common for the IAA to sputter like this? Assuming it is the IAA and not the acro tumor. I wish it could make up its mind. This is so taxing both mentally and physically.


Thinking about Karen & Joe, yesterday was a sad day for the Doodles clan and all of us in L&L.
Hope all the kitties are doing good.

 

[saltycat]

more HC at +4, he is being stubborn coming up today, looks like he will be a happy camper if he keeps this up with all the tasty gravy he will be getting.

 

[Doodles & Karen]

Is it common for the IAA to sputter like this

Capt Jack!!! There were a few too many time periods where I certainly couldn't get Doodles dose anywhere near stable so part of it is likely the IAA. Capt. Jack has even more unpredictability because of the Acro on top of it. @Wendy&Neko as well as @Sandy and Black Kitty hopefully can lead their helping hand.

BTW, Doodles has officially passed on "Rotten Cat" to your boy. I asked Doodles not to do that but obviously he didn't listen as usual.

Be cautious, skip a shot if needed, he'll recover, they always do.

 

[Sandy and Black Kitty]

I think it is dangerous for anyone to shoot the 40s.

For a high dose cat with an IAA of 65% that has been active at least 7 months at the first glimpse of unexpected downward movement extreme caution is required.

Is it common for the IAA to sputter like this? Assuming it is the IAA and not the acro tumor. I wish it could make up its mind. This is so taxing both mentally and physically.

unfortunately there is no common. This could be the result of the IAA breaking at the same time the acro is acting up. There is no way to measure either how much insulin is being released by the IAA and/or how much the Acro is messing with that insulin.

Time for a new strategy. Gotta run right now however will BBL

 

[carfurby (GA)]

 

[Bobbie And Bubba]

Wow Jack, what the heck??

 

[saltycat]

While I have learned a lot and know more then I would like about FD and IAA/Acro, I know there is a TON that I don't know. Thank you for popping in and offering some veteran advice, I read all of it a few times to make sure I digest it and every trick I've learned dealing with Jack has come from someone on the boards here.

I think it is dangerous for anyone to shoot the 40s.

Jack has definitely been testing my knowledge the last month or so. Why I shot low the last 2 days: Being on Lev I know I have a few hours before it kicks in and got some carbs in him before the cycle started. If I could not test continuously, I would have been much more cautious yesterday and today and not shot the amount I did. He has the classic acro hunger so getting hc in him is rarely an issue. Worst case scenario, my vet is 5 min from the house, 3 if I REALLY need to get there.

I'm not sure if that is the right thing to do, but above is why I did it.

The quagmire that I run into is skips shoot Jack into the high 400's+ quickly. I have been shooting BCS shots with low numbers to be safer while preventing such a dramatic rise. Already today on 24u he is up to 283 at +9, a skip would have him in the rafters. Maybe I am stuck in the patterns I learned before the IAA/Acro started becoming more unpredictable. It seemed letting him sit too high just meant climbing the dosing ladder. Being more aggressive seemed to help keep the dose from constantly rising. I get more worried when I miss a late night test or he pulls a late night dive then shooting low numbers when I can monitor.

So, since all that is in the past, I guess I'm not sure how to handle his numbers these days and could use some advice. We went from 38u down to 22u and had climbed back up to 34u up until a few days ago. The last three days have really confused me. I thought a bounce was starting on 3/6, but he had other plans. It seems getting late night tests are more important now, but are not easy for me to do long term.

Any advice you have on dealing with an erratic tumor / antibodies is greatly appreciated. It seems I might be entering another phase in dealing with Jack that requires some changes to how I have been shooting.

Wow Jack, what the heck??

That is about what I said, although there may have been a few added words in there.

BTW, Doodles has officially passed on "Rotten Cat" to your boy.

He has taken it to heart the last few days that is for sure! If he keeps this up, he will get an adjective added to the front of that title that is not family friendly

 

[Sienne and Gabby (GA)]

I understand your rationale and on one level it makes sense but at another I think you are treading on thin ice. For a non-high dose cat, we don't shoot numbers below 50. I'm one of those veterans who would literally shoot any number above a 50. BUT, the point is that you are not shooting low and then shoveling HC food into your cat. With both Lantus and Lev, ideally, when you shoot low the numbers stay low. The curve is "flat."

When you have a high dose cat, there are a number of other considerations. With acro, is the tumor revving down and as a result, pumping out less growth hormone and numbers are lower? With IAA, is the resistance breaking? In either case, shooting a low number can be dangerous because you don't know what may be causing numbers to drop. With acro, because the beta cells in the pancreas are still active, food stimulates insulin production and you may literally have to shovel as much HC into your cat as you can to offset the dropping numbers. Sandy can tell you more about dealing with breaking insulin resistance. Keeping records of what you're feeding when you're shooting low will also help both you and us so everyone has an understanding of how Jack is responding. Part of the process is also having enough data to guide your dosing/shooting strategy.

At the very least, I'd urge you to adopt the basic rule of not shooting numbers below 50. If you're able to stall and see if numbers are rising, that is likely to be safer. I've not had to manage a high dose cat myself so I will defer to Sandy, @Wendy&Neko and @julie & punkin (ga).

 

[saltycat]

Thanks for the input Sienne. I agree that while it seems logical, what I am doing may be the wrong approach. It is always good to get other members thoughts. Since remission is highly unlikely with Jack, it might be best to back off a bit on shooting low numbers. If the consensus is don't shoot under 50, I can easily incorporate that into the routine.

Would you also apply that to token doses like yesterday and today? I wouldn't even consider a full size dose with those low numbers, but a 2/3 shot I was more comfortable with... right or wrong.

I've always put what I fed in the SS with the numbers. I've found it helps me just as much as anyone else to see why the numbers came up and what it took to get there. The SS has been invaluable even just for my own reference.

It is always a guessing game which condition is affecting the numbers, is the tumor doing its thing or are the antibodies having a weird day or is Jack just being a cat today. While Jack's pancreas is still trying to do its thing, the insulin never makes it to the cells since the IGF-1 clogs up all the receptors. Even with 24u today, he'll be pink by pmps. He frequently has 100pt food spikes after lc meals, so the pancreas just can't out-compete the IGF-1.

The IAA is a big part of why I have been more aggressive with his dosing. It seems, at least anecdotally, that keeping them in better numbers keeps the IAA from ramping up and causing a never ending climb up the dosing ladder.

Thanks again for the veteran's view on things. I think I need to adjust the game plan a bit, but I'm just not sure the best way to do it.

 

[Wendy&Neko]

And there he goes!

It is always better to stall under 50 and make sure kitty is well on his or her way up before shooting. Then you can be more comfortable giving the full dose, or at least the dose of the newly earned reduction. I always stalled Neko when she gave me a 40's at preshot. Like you I knew she had hours to onset, but I also wanted to make sure she was on her way up and wasn't getting a double dip. And she didn't always get a food bump. Of course, I had no problem shooting a 51.

 

[Sandy and Black Kitty]

While I have learned a lot and know more then I would like about FD and IAA/Acro, I know there is a TON that I don't know.

Being that BK was IAA only, I can only speak to that side of things and honestly the sad truth is we know very little.
Here is what we do know about IAA:

• Injected insulin first gets bound to the antibodies. Any insulin that does not get bound goes toward metabolizing sugars. How much goes to antibodies and how much goes to metabolizing sugars is anybody’s guess and a moving target

• IAA can retard the initial rise of available insulin after an injection.

• IAA can lead to an increase in the half-life of free (unbound) insulin in circulation because some bound insulin gets released into circulation. This increase in half-life can lead to prolongation of action

• The release of insulin from the antibodies can happen at inopportune times

• When insulin sensitivity returns, it can happen quite suddenly. At these times, large amounts of insulin previously bound to the antibodies may be released, so avoiding hypoglycemia is a major concern.

The quagmire that I run into is skips shoot Jack into the high 400's+ quickly.

I went looking for an example of the effects of skipped shots and could not find any...can you point out examples of this on your ss?

IAA does require a certain aggressiveness in approach but you dont want to be so aggressive that you are getting stuck in a loop of him diving into the lower 40s, triggering a huge bounce that makes you want to be more aggressive. Know what I mean?

I guess I'm not sure how to handle his numbers these days and could use some advice. We went from 38u down to 22u and had climbed back up to 34u up until a few days ago.

Both IAA and Acro create unpredictability. Ups and downs in dose are to be expected. In time you will learn to roll with it, to 'go with the flow'. He needs however much he needs.

It seems getting late night tests are more important now, but are not easy for me to do long term.

They are indeed important. Many kitties go lower in the PM cycle. Missing the hours from PM+6 to AMPS means missing 1/4 of the picture. Always sprinkle a few tests across the bottom half of the PM cycle - a +9 one night, a +10 another night etc. When you stand back an look at the ss there should not be any wide open spaces where there is no data whatsoever. This applies to all sugar-kitties.

I recommend that you do not shoot under 50 - safety first.
As far as BCSs go, keep in mind that with IAA you are more likely to see the effects in the cycle following the cycle of the BCS.
Best to err on the side of caution - if it turns out to be a misstep use R to shoot down any resulting ugliness.

It's not easy - I know, but hang in there and hang in here. Its the best place a high dose kitty can be. .